Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Division of Gastroenterology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Aliment Pharmacol Ther. 2024 Apr;59(8):928-940. doi: 10.1111/apt.17918. Epub 2024 Mar 4.
Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed.
To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition.
We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2.
There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation.
This systematic review is the first step for a structured program to develop a stricture IUS index for CD.
狭窄型克罗恩病（CD）最常发生在末端回肠，构成临床难题。肠超声（IUS）、计算机断层肠造影术（CTE）和磁共振肠造影术（MRE）等横断面成像方式可评估整个肠壁和相关肠外表现。CTE 和 MRE 已制定了狭窄的放射学定义；正在指数开发计划中评估其可靠性和反应性。需要制定一种使用 IUS 全面评估狭窄的策略。
详细总结 IUS 上狭窄的定义、诊断和监测以及图像采集的技术方面。
我们在四个数据库中搜索，截至 2024 年 1 月 6 日。重复进行两阶段筛选。我们使用 QUADAS-2 评估偏倚风险。
有 56 项研究符合纳入标准。IUS 上狭窄的定义存在异质性，但总体诊断狭窄的准确性较高。IUS 对狭窄处炎症与纤维化进行特征描述的能力还不够准确，无法在临床实践或试验中使用。我们总结了 IUS 上狭窄改善的定义，并讨论了图像采集和标准化的参数。
这是为 CD 的 IUS 狭窄指数制定一个结构化计划的第一步。
